Clinical Evaluation Tools Purpose This session provides an overview of a variety of typical clinical evaluation tools that the new clinical educator may use for student evaluation. Through discussion and a small-group activity, participants are exposed to the major evaluation tools. Depending on when and where the participants attended nursing school, the concept map and other tools may be new to them. The hands-on activity in using a clinical performance rubric helps build participants skills and prepares them for their first clinical rotation with students. This session is the practical application of the previous session, Clinical Evaluation: Concepts and Processes (Tab 5). Time 60 minutes Outline Objectives Clinical Evaluation Tools Tools for Evaluation: Assignments Observation Clinical Performance Rubric Patient Assessment Nursing Care Plans Concept Maps Clinical Evaluation Activity Student Self-Evaluation Student-Faculty Relationships Summary Materials Needed PowerPoint Slides 6-1 through 6-23 Examples of concept care maps that students have created Clinical Evaluation Activity Handouts (Tab 6 of the participant notebook, pages 8-13): Student Scenario and Clinical Evaluation Rubric Patient Assessment Tool Nursing Care Plan Concept Care Map Copyright 2008 by The Health Alliance of MidAmerica LLC 1
Clinical Evaluation Tools Opening PPT 6-1 Introduce yourself and your role. Share some background information on your expertise with clinical evaluation. The purpose of this session is to review with you, the participants, the types of clinical evaluation tools that might be encountered when evaluating students in clinical practice. The decision as to which evaluation tools are to be used is often made by the full-time or permanent faculty in the clinical course. As adjunct clinical instructors, you are obligated to follow the evaluation methods established by the course faculty and offer suggestions for change when needed to the course faculty. More than likely, you will not use all of these methods in a semester. However, having an understanding of the various methods is important. Objectives PPT 6-2 Highlight the objectives for this session. Explain that after discussing the major evaluation methods and tools, participants will work in small groups to practice using a clinical performance rubric. Tools for Evaluation PPT 6-3 Briefly review with the participants the tools that the faculty member uses to evaluate students: direct observation, preceptor or staff observation, anecdotal notes, and clinical performance rubrics. Copyright 2008 by The Health Alliance of MidAmerica LLC 2 Clinical Evaluation Tools
Tools for Evaluation: Assignments PPT 6-4 The evaluation methods on this slide may be assigned to the students to assist faculty members in the evaluation process. These methods or tools help to evaluate students cognitive, affective, and psychomotor domains. These methods include: journals/reflection papers, process recordings, portfolios, patient assessment forms, nursing care plans, concept maps, medication profiles, and student self-evaluations. Observation PPT 6-5 Observation is the main method faculty members use in the student evaluation process. Observation occurs in the skills lab using observation guides in the form of checklists during skill demonstrations. There is direct clinical observation in the clinical setting by the faculty member, the preceptor, or even the staff member. After observing students, faculty members often keep anecdotal notes to remember specific information about their observations. According to O Connor (2001), anecdotal notes should include a description of: Care the patient received What the student did or failed to do in providing care Any situational or environmental factors that contributed to the observed situation In addition to anecdotal notes, faculty may choose to use a clinical performance rubric to record student performance, which will be presented next. What is a clinical performance rubric? PPT 6-6 The clinical performance rubric is a listing of predetermined behaviors that faculty members want students to be able to consistently perform in a safe and satisfactory manner for students to achieve a passing score. The predetermined behaviors on the rubric should be derived from the clinical course learning outcomes. The rubric also delineates a quality rating to the performance of behaviors such as satisfactory, needs improvement, and unsatisfactory. Copyright 2008 by The Health Alliance of MidAmerica LLC 3
Why develop a clinical rubric? PPT 6-7 First, the clinical performance rubric provides the brand new student with a list of behaviors faculty expect them to perform by the end of the first clinical course. For the new student, the rubric can help them better understand the nurses role and responsibilities. Second, a copy of the rubric with faculty comments/feedback provides the student with a concrete view of their performance. The completed rubric also can be a guide for faculty when giving the student verbal feedback. Third, the rubric helps faculty identify poor student performance early in the term so the student then has time to make improvements. Fourth, the clinical rubric provides the new faculty member with examples of behaviors to be evaluated. It also provides a mechanism for assigning a letter grade to a clinical course by assigning a numerical value to each rating. Rubric Rating Scales PPT 6-8 These are two examples of rubric rating scales that could be adapted. The Clinical Competence Rating Scale was adapted from Dr. Kathleen Bondy by Dr. Linda J. Scheetz (2000). According to Sheetz, this rating scale has been tested and has evidence of reliability and validity. It uses the ratings of independent, supervised, assisted, marginal, dependent, not applicable, and not observed. Chrisman (2007) has found that this rating scale is best used during skills demonstrations and possibly in a clinical capstone course. According to Chrisman (2007), students had previous experience with the rubric verbalized appreciation when the faculty member used the Not Applicable and Not Observed categories versus the faculty member trying to judge a student s behavior they could not have possibly observed. Copyright 2008 by The Health Alliance of MidAmerica LLC 4
Another example of a rating scale used at Keele University (Priest, 1998) includes the descriptors of outstanding, very good, good, average, poor, unacceptable, and not assessed. Chrisman recommends that when using a clinical performance rubric you should use the clinical rating scale already in place by the institution where you work. Faculty Guidelines for Clinical Rubric Management PPT 6-9 The following guidelines were used by Chrisman when she implemented the clinical rubric. First, each student received a copy of the rubric during clinical orientation. They were given time to review the behaviors and the layout of the rubric and were encouraged to ask questions. Of course, because this was their first clinical course, they really did not know what to ask initially. Second, faculty should checkmark each behavior they observed and how they rated the quality of the student performance (satisfactory, needs improvement, or unsatisfactory). The faculty member then writes comments for every needs improvement and unsatisfactory rating. Positive comments about their satisfactory performance are always appreciated by the students. Third, the faculty member should give the student a copy of the rubric with the feedback before the next clinical week. Faculty should then review their written comments with the student ASAP to answer student s questions and to ensure the student is interpreting faculty comments as intended. Example of Clinical Outcomes PPT 6-10 The list on Page 3 of Tab 6 in the participant notebook is an example of clinical outcomes for a first clinical practice course. The focus of the first outcome is client, health, and environment. The second outcome focuses on nursing and the individual. The focus of the third outcome is critical thinking. The fourth is communication. The fifth is therapeutic nursing interventions. The learning outcomes of a specific course generally reflect the nursing program outcomes. Copyright 2008 by The Health Alliance of MidAmerica LLC 5
Clinical Outcome 1.1a Identifies disease processes, psychological and sociocultural factors that affect the client's health Satisfactory Needs Improvement Unsatisfactory 6-11 The student defines/describes patient s primary medical diagnosis and/or surgical intervention. The student defines patient s medical diagnosis or surgical intervention with assistance of faculty. The student is unable to identify patient s primary medical diagnosis or surgical procedure. Clinical Outcome 1.1a Identifies disease processes, psychological and sociocultural factors that affect the client s health: Example of a Rubric PPT 6-11 The chart found on page 3 of the participant notebook (Tab 6) and on the slide is a sample of how the descriptors (satisfactory, needs improvement and unsatisfactory) are differentiated for a clinical course outcome 1, subobjective 1a. Satisfactory Needs Improvement Unsatisfactory The student defines/describes patient s primary medical diagnosis and/or surgical intervention. The student defines patient medical diagnosis or surgical intervention with assistance of faculty. The student is unable to identify patient s primary medical diagnosis or surgical procedure. Patient Assessment PPT 6-12 The patient assessment form or tool is one of the most common evaluative methods used to evaluate student understanding, accuracy, and comprehensiveness. The assessment form usually is accompanied by a medication profile, a nursing care plan, or a concept care map. The patient assessment form is typically graded by the clinical faculty member with feedback. There is a place on the clinical performance rubric to indicate the quality of the student s work. Typically, one assessment tool is required for each assigned patient. Patient Assessment PPT 6-13 The patient assessment form often contains the following sections patient demographics; chief complaint; history current/past medical and surgical; allergies and current medications; IV information; laboratory, diagnostic tests and procedures; physician orders; and pathophysiology review. How the patient assessment tool is configured depends on course faculty preference. Copyright 2008 by The Health Alliance of MidAmerica LLC 6
Nursing Care Plan PPT 6-14 The nursing care plan (NCP) is the next most common method used to evaluate student understanding of the nursing process. The purpose of the NCP is to provide the student with a plan of care for one patient problem that is to be followed during the day. It is considered a working document that, at the end of the clinical week, should reflect changes to the plan as needed. A draft of the student s NCP should be reviewed in the morning of the first clinical day of the week. This initial draft demonstrates student preparedness and knowledge. The format for the NCP is fairly standard and includes the nursing diagnosis, outcomes, interventions, rationale, and outcome evaluations. Remember, patient outcomes are behavioral changes that can be demonstrated and measured and must be achieved within a specified time frame. The key points of evaluation include the following. (a) The NCP is individualized for the patient. (b) The NCP includes all parts in an organized manner. (c) Rationales help to demonstrate knowledge of theory. (d) The student should reference the rationale as required by faculty. The NCP is typically part of formative evaluation and is graded by faculty with feedback. The clinical performance rubric does include the NCP in outcome #5. Nursing Care Plans Advantages and Disadvantages PPT 6-15 The advantages of the NCP are that it is a standardized approach to demonstrating understanding of the nursing process, it is a vehicle for demonstrating critical thinking and reasoning, and it helps the student learn how to think like a nurse. The disadvantages of the NCP are that there are standardized care plans available, which causes students to question the value of developing others. If standard NCPs are used, then does critical thinking really occur? The traditional linear NCP has been criticized by those who believe the nursing process does not reflect nursing practice. And, there also is the attitude that because real nurses do not write care plans, why should the students? Copyright 2008 by The Health Alliance of MidAmerica LLC 7
Concept Maps PPT 6-16 A new and competing method of demonstrating understanding of the nursing process and student understanding of the whole patient is the concept care map. The concept map is a diagrammatic teaching strategy that helps students to demonstrate how the patient assessment tool is configured, depending on course faculty preference and the relationships between data. The concept care map shows a student s ability to organize a large amount of data. It takes the place of a traditional NCP. It also is a part of student s formative evaluative process and is graded with feedback. Concept Maps Advantages and Disadvantages PPT 6-17 The advantages of the concept care map are that it is a creative process that shows synthesis of information data and requires less writing. The disadvantages of the concept map are that it may be large and difficult to follow, no two maps will be the same, and attractiveness of the map may influence faculty evaluation of the students abilities. Concept Maps Types PPT 6-18 Students can use the concept map format to demonstrate understanding of the patient s pathophysiologic processes, the nursing process, or they can use the format to demonstrate both the nursing process and the pathophysiology behind the patient outcomes and nursing interventions. The combined pathophysiologic and nursing care concept map provides the student with an opportunity to visualize and integrate theories with the nursing process (Daley, 1996; Irvine, 1995; Kathol, Geiger, & Hartig, 1996). Concept Care Map Show examples of concept care maps that you have brought. Point out the resources listed in Tab 11 for participants who want additional information on concept care maps. Copyright 2008 by The Health Alliance of MidAmerica LLC 8
Clinical Evaluation Activity Introduction PPT 6-19 Divide the participants into groups of two to four, depending on room configuration. Use the instructions on page 6 (Tab 6) of the participant notebook to introduce the activity to the participants. Go through the student scenario and explain to the participants that they are being asked to review the patient assessment tool, the nursing care plan, and the concept care map. Explain they are to use the portion of the clinical performance rubric to record their evaluation of the written work and add comments to the rubric for the student. Give them about 15-20 minutes for the small group to work and then move to the next slide to debrief this activity. Clinical Evaluation Activity Issues Concerns Likes and Dislikes What if? Clinical Evaluation Activity Debrief PPT 6-20 After the activity, offer the participants time to ask questions and bring up any issues, concerns, their likes and dislikes. Ask if they have any what if scenarios they would like to explore. 6-20 Student Self-Evaluation PPT 6-21 Students are now being asked to evaluate their clinical performance weekly. Sometimes, faculty members ask the students to evaluate themselves based on the clinical evaluation tool or the clinical performance rubric. At other times, faculty want the students to examine what they learned, what their strengths were, identify where they want to improve, and how they plan to improve. Many students have difficulty with this activity. They often feel unsure because they don t know what the faculty member wants to see written. They do not know how to provide rationale or supportive data when they say that they demonstrated understanding of the patient s medical diagnosis and surgical procedure. Well, how did they do that? What supportive information can they offer? Copyright 2008 by The Health Alliance of MidAmerica LLC 9
Encourage your students to give details. If they do not give details, send the evaluation back and indicate you are unable to evaluate what they have written and you need more information/examples are needed. According to Oermann and Gaberson (2006), students in the first clinical course may need assistance with identifying their strengths and areas needing improvement. Faculty need to assist students in the identification of strategies to improve their performance. The self-evaluation process is only for formative evaluation and is not graded, according to Oermann and Gaberson. Student-Faculty Relationships PPT 6-22 According to Gaberson and Oermann (1998), it is the job of the clinical faculty to foster positive relationships with their clinical students by displaying confidence in the students, showing them respect, keeping clinical expectations realistic (first clinical course behaviors versus the final clinical course behaviors), being honest and direct when giving feedback, staying approachable, displaying caring behaviors, and remaining supportive and encouraging about their potential for improvement and growth. With problem students, you should step back and make sure you are not the problem. If you decide you might be part of the problem, be honest with the student and let them know what you will do to make changes and then guide them to understand their responsibilities in the change process. Make a commitment to help this student to become the best nurse during the time you have them. Of course, this may be difficult if you have very short clinical rotations. If you are sure the student may have difficulty being successful no matter what you or the student does, evaluate them weekly using the rubric, and keep them informed. And, remember to document, document, and document. Document all student behavior that demonstrates unsatisfactory performance. Copyright 2008 by The Health Alliance of MidAmerica LLC 10
Summary PPT 6-23 In conclusion, during this session we: Introduced various clinical evaluation tools available to faculty Discussed the development and use of a clinical performance rubric Reviewed guidelines for providing clinical feedback to students Compared the traditional nursing care plan with the concept care map Discussed how to develop positive student-faculty relationships Practiced using the clinical performance rubric based on a student scenario and paperwork examples The overall goal of this session was to help familiarize you with the various methods of clinical evaluation and introduce the clinical performance rubric and the concept care map. New clinical faculty are not expected to be perfect at clinical evaluation, so it is important you keep in touch with the full-time or permanent course faculty, ask lots of questions and ask for guidance as you begin your journey of clinical evaluation. Remember, the student s job is to learn, and the clinical faculty s job is to be the student s guide. Good luck to each of you. FILE: G-CFA Instructor Tab 6 Clinical Eval Tools Copyright 2008 by The Health Alliance of MidAmerica LLC 11